Mason Thomas, Jones Cheryl, Sutton Matt, Konstantakopoulou Evgenia, Edgar David F, Harper Robert A, Birch Stephen, Lawrenson John G
Manchester Centre for Health Economics, University of Manchester, Manchester, UK.
Division of Optometry and Visual Science, Applied Vision Research Centre, University of London, London, UK.
BMJ Open. 2017 Jul 10;7(7):e014089. doi: 10.1136/bmjopen-2016-014089.
This research aims to evaluate the wider health system effects of the introduction of an intermediate-tier service for eye care.
This research employs the Minor Eye Conditions Scheme (MECS), an intermediate-tier eye care service introduced in two London boroughs, Lewisham and Lambeth, in April 2013.
Retrospective difference-in-differences analysis comparing changes over time in service use and costs between April 2011 and October 2014 in two commissioning areas that introduced an intermediate-tier service programme with changes in a neighbouring area that did not introduce the programme.
MECS audit data; unit costs for MECS visits; volumes of first and follow-up outpatient attendances to hospital ophthalmology; the national schedule of reference costs.
Volumes and costs of patients treated.
In one intervention area (Lewisham), general practitioner (GP) referrals to hospital ophthalmology decreased differentially by 75.2% (95% CI -0.918% to -0.587%) for first attendances, and by 40.3% for follow-ups (95% CI -0.489% to -0.316%). GP referrals to hospital ophthalmology decreased differentially by 30.2% (95% CI -0.468% to -0.137%) for first attendances in the other intervention area (Lambeth). Costs increased by 3.1% in the comparison area between 2011/2012 and 2013/2014. Over the same period, costs increased by less (2.5%) in one intervention area and fell by 13.8% in the other intervention area.
Intermediate-tier services based in the community could potentially reduce volumes of patients referred to hospitals by GPs and provide replacement services at lower unit costs.
本研究旨在评估引入中级眼科护理服务对更广泛的卫生系统的影响。
本研究采用了小眼病治疗计划（MECS），这是一项于2013年4月在伦敦的刘易舍姆和兰贝斯两个行政区推出的中级眼科护理服务。
回顾性差分分析，比较了2011年4月至2014年10月期间引入中级服务计划的两个委托区域与未引入该计划的相邻区域在服务使用和成本方面随时间的变化。
MECS审计数据；MECS就诊的单位成本；医院眼科首次和后续门诊就诊量；国家参考成本表。
接受治疗患者的数量和成本。
在一个干预区域（刘易舍姆），全科医生（GP）转诊至医院眼科的首次就诊量差异下降了75.2%（95%CI -0.918%至-0.587%），后续就诊量差异下降了40.3%（95%CI -0.489%至-0.316%）。在另一个干预区域（兰贝斯），全科医生转诊至医院眼科的首次就诊量差异下降了30.2%（95%CI -0.468%至-0.137%）。在比较区域，2011/2012年至2013/2014年期间成本增加了3.1%。在同一时期，一个干预区域的成本增加较少（2.5%），而另一个干预区域的成本下降了13.8%。
基于社区的中级服务可能会减少全科医生转诊至医院的患者数量，并以较低的单位成本提供替代服务。
